Association Between Food and Drug Administration Approval and Disparities in Immunotherapy Use Among Patients With Cancer in the US

Ermer, Theresa; Canavan, Maureen; Maduka, Richard C.; Li, Andrew X.; Salazar, Michelle C.; Kaminski, Michael F.; Pichert, Matthew D.; Zhan, Peter L.; Mase, Vincent J.; Kluger, Harriet M.

doi:10.1001/jamanetworkopen.2022.19535

Cited by 13 publications

(8 citation statements)

References 61 publications

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“…In the past decades, anti-cancer immunotherapy has changed from a promising treatment method to a reality of clinical treatment. Many immunotherapy programs that can be used for patients with cancer have now been approved by the US FDA and European Medicines Agency and many other treatment programs are being studied as independent therapeutic interventions or in combination with clinical routine treatment ( 174 , 175 ). Treatment strategies are no longer based solely on interfering with metabolism of tumor cells or whether it is a purely clonal proliferative disease.…”

Section: Discussionmentioning

confidence: 99%

Immunotherapy: A new target for cancer cure (Review)

et al. 2023

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Cancer is the leading cause of death globally and there is a worldwide cancer epidemic. Immunotherapy has emerged as a promising anticancer therapy. In particular, oncolytic viruses destroy cancer cells without destroying normal tissue via viral self-replication and anti-tumor immune responses, showing potential for cancer therapy. The present review discusses the role of the immune system in the treatment of tumor. The strategies for treating tumors are briefly introduced from aspects of active immunization and passive immunotherapy and the dendritic cell vaccines and oncolytic viruses are highlighted, as well as use of blood group A antigen in the treatment of solid tumors.

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Section: Discussionmentioning

confidence: 99%

Immunotherapy: A new target for cancer cure (Review)

et al. 2023

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“…This is an important albeit unsurprising finding, as it mirrors the known disparate access to care in HNC. While previous studies have found racial and ethnic disparities in access to immunotherapy in other cancer sites, our study makes a novel contribution by describing a potential disparity specific to HNC using clinical data. Of all cancers, HNC has the third-worst survival disparity between Black and White patients, and the disparate receipt of immunotherapy reported in this study illustrates how new therapeutics, while potentially effective, may inadvertently exacerbate already existing survival disparity .…”

Section: Discussionmentioning

confidence: 99%

Differences in Receipt of Immunotherapy Treatment Among Patients With Head and Neck Cancer

Ramkumar,

Bhardwaj,

Patel

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceThe US Food and Drug Administration approved immune checkpoint inhibitors (immunotherapy) for select cases of head and neck squamous cell carcinoma (HNSCC) in 2016. However, it is unclear whether there are clinical or sociodemographic differences among patients receiving immunotherapy as part of their care. Given the known disparities in head and neck cancer care, we hypothesized that there are differences in receipt of immunotherapy among patients with HNSCC based on clinical and nonclinical characteristics.ObjectiveTo characterize clinical and nonclinical factors associated with receipt of immunotherapy among older patients with HNSCC.Design, Setting, and ParticipantsThis retrospective cohort study included patients 65 years or older diagnosed with HNSCC (n = 4860) in a community oncology care setting. Electronic health records from Navigating Cancer were assessed from January 1, 2017, to April 30, 2022.Main Outcomes and MeasuresMultivariable logistic regression was used to characterize clinical (tumor stage [localized vs advanced] and anatomical subsite [oropharyngeal vs nonoropharyngeal]) and nonclinical (age, smoking history, race and ethnicity, sex, and marital status) factors associated with receipt of immunotherapy.ResultsIn the study cohort of 4860 patients, 3593 (73.9%) were men; 4230 (87.0%) were White and 630 (13.0%) were of other races. A total of 552 patients (11.4%) had received immunotherapy. After adjusting for covariates, in the final model, White patients with HNSCC had 80% increased odds of receiving immunotherapy (adjusted odds ratio [AOR], 1.80 [95% CI, 1.30-2.48]) compared with patients of other races. There were no statistically significant differences in the odds of receiving immunotherapy based on age, sex, or smoking history. Patients with nonoropharyngeal disease were significantly more likely to receive immunotherapy than those with oropharyngeal cancer (AOR, 1.29 [95% CI, 1.05-1.59]), as were those with advanced compared with local disease (AOR, 2.39 [95% CI, 1.71-3.34]).Conclusions and RelevanceThe findings of this cohort study suggest that among older patients with HNSCC, White patients may be more likely to receive immunotherapy as part of their care. Equitable access to immunotherapy and other treatment options will reduce cancer-related health disparities and improve survival of patients with HNSCC.

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“…An extensive literature has documented disparities in the receipt of different cancer treatments by race/ethnicity, SES, geographic location, and type of health insurance coverage, 34,[67][68][69][70][71][72][73] including studies showing disparities in the receipt of guideline-concordant treatment for many cancer types, such as cancers of the lung, 74,75 colorectum, 76,77 breast, 78,79 pancreas, 80,81 uterus, 82,83 ovary, 84,85 esophagus, 86 and head and neck. 87 Even if they receive cancer treatment, people of color and of lower SES are more likely to experience treatment delays, which can adversely affect the outcome.…”

Section: Disparities In Receipt Of Treatmentmentioning

confidence: 99%

American Cancer Society’s report on the status of cancer disparities in the United States, 2023

Islami,

Baeker Bispo,

Lee

et al. 2023

CA A Cancer J Clinicians

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In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6–2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black–White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black–White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence‐based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.

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Association Between Food and Drug Administration Approval and Disparities in Immunotherapy Use Among Patients With Cancer in the US

Cited by 13 publications

References 61 publications

Immunotherapy: A new target for cancer cure (Review)

Immunotherapy: A new target for cancer cure (Review)

Differences in Receipt of Immunotherapy Treatment Among Patients With Head and Neck Cancer

American Cancer Society’s report on the status of cancer disparities in the United States, 2023

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